After years of heated debates, disagreements, and extensions, the World Health Organization (WHO) has finalized a landmark global treaty aimed at improving pandemic preparedness, response, and prevention. The treaty, years in the making, offers a framework for ensuring equitable access to vaccines, therapeutics, and diagnostics during future global health emergencies. While the agreement has been hailed as a triumph of multilateralism, it is notably missing a key player: the United States, which withdrew from the WHO under President Donald Trump’s administration.
The pandemic accord—officially known as the Pandemic Prevention, Preparedness, and Response Agreement—was finalized in April 2025 after three years of intense negotiations between 191 countries, excluding the U.S. The absence of the U.S. has raised concerns about the treaty’s future effectiveness and highlights the challenges of global cooperation in a time of rising nationalism.
As WHO’s Director-General, Tedros Adhanom Ghebreyesus, declared, “The nations of the world made history in Geneva today.” Yet, for some, that history is tainted by the withdrawal of one of the world’s largest contributors to global health. “The U.S. departure was a profound loss to global health,” said Lawrence Gostin, a legal expert on health policy at Georgetown University. “But, strangely enough, it seemed to galvanize other countries, particularly Europe, to push through with the agreement.”
Key Provisions and Challenges
The treaty primarily aims to address the inequities exposed during the COVID-19 pandemic, such as the hoarding of vaccines by wealthier nations, leaving developing countries without adequate access. The agreement includes provisions for a Pathogen Access and Benefit Sharing (PABS) system that will ensure the equitable distribution of medical supplies during pandemics. Countries will also be required to share vital pathogen samples and genetic sequences with manufacturers who can create the necessary vaccines and therapeutics.
The details of how intellectual property and technology transfers will work have yet to be fully ironed out. The initial drafts proposed voluntary terms for technology transfer, but after intense negotiations, the final treaty mandates that these transfers be “mutually agreed upon,” without prejudicing the rights of the parties involved in other international agreements. This marks a delicate balance between the need for innovation and the imperative of equitable access.
Perhaps the most significant challenge to the treaty’s future success is the issue of enforcement. While the treaty is legally binding, it will require at least 60 countries to ratify the terms before it can become international law. The real test will lie in whether nations, pharmaceutical companies, and international organizations are willing to uphold the principles of equity and open access to life-saving resources.
The U.S. Withdrawal: A Missed Opportunity for Global Leadership
The decision by the U.S. to withdraw from WHO under Trump’s leadership remains a critical turning point in the history of global health governance. The U.S., which had been one of the key negotiators in the early stages of the treaty discussions, left a significant power vacuum in the negotiations. Some observers, however, believe that the absence of the U.S. ultimately pushed other nations to demonstrate the strength of multilateralism. “The treaty was agreed not in spite of Trump, but because of Trump,” said Lawrence Gostin.
The withdrawal of the U.S. was a blow to global health cooperation, especially considering the country’s resources, expertise, and influence in the field. The Biden administration, though returning to WHO after taking office in 2021, has been unable to undo the damage caused by the initial exit.
A Long Road Ahead
While the treaty’s approval is a monumental achievement, the road ahead is far from simple. The treaty is not a cure-all but lays the groundwork for a more coordinated, equitable global response to future pandemics. The next steps will involve translating the treaty’s principles into actionable frameworks that can be enforced during a crisis. This includes addressing the critical issue of vaccine equity, which was a major failing during the COVID-19 pandemic.
As WHO’s Tedros emphasized, “This agreement provides the recipe and all the ingredients for a world safer from pandemics. Countries now need to make it happen.”
The global health community must now focus on ensuring that this historic accord is not just a document, but a living framework capable of protecting future generations from the catastrophic impact of pandemics.
Sources:
Global Pandemic Treaty Finalized, Without U.S., in ‘A Victory for Multilateralism. Science Magazine, April 2025.
Pandemic Accord: Global Health Game Changer or Empty Promises? BMJ, April 2025.
Historic Pandemic Treaty is a Triumph in a World Being Torn Apart. Nature, April 2025.